ECT use in the public sector: California.

Availability of ECT in the United States often has been greater in the private sector than in the public sector. This is especially true in California, where ECT is heavily regulated. In 1986, ECT was available at 29.6% of the public hospitals and 42.9% of the private hospitals with psychiatric units in California. Public hospital patients accounted for 8.5% of all ECT in the state, while private hospital patients accounted for 91.5%. Of the 88 patients unable to give informed consent, 34.1% came from public hospitals vs. 65.9% from private hospitals. Two university-affiliated county hospitals accounted for 43 of 52 patients (82.7%) treated in the 6 county hospitals with psychiatric units. White patients accounted for 92.4% of ECT, leaving minorities undertreated. Private patients have a greater degree of choice regarding changing physician or hospital if ECT is needed but unavailable. The choices for public patients are limited. Possible causes and potential solutions to this problem are discussed.